OpEd: lllinois patients are paying for flaws in 340B program (Chicago, IL) — More than 1.3 million Illinoisans live with diabetes, a disease marked by daily, relentless calculations of blood sugar, food, medication, activity, emotions and cost.
That last part—cost—should trouble every policymaker.
Even with major progress on insulin affordability, many people with diabetes struggle under the weight of a costly system. Medication rationing and prescription abandonment remain a primary driver of emergency room visits, and when preventable complications turn into hospital stays, it is both devastating and costly for patients and families.
This is one of many reasons why Illinois lawmakers should be careful before expanding or locking the current version of the federal 340B drug pricing program into law.
The 340B program was created for a good reason: to help safety-net providers better serve low-income and uninsured patients. We support that mission. We also know that many hospitals and clinics are vital resources, especially in rural and underserved communities.
But the current 340B system has drifted too far from its original purpose. In many cases, it has become a revenue stream for large hospital systems, pharmacy benefit managers (PBMs), and for-profit pharmacies, with little to no impact on the vulnerable populations it was designed to serve.
340B allows eligible hospitals to buy specific drugs at steep discounts and bill payers at much higher rates. The difference is supposed to be invested into caring for patients with little or no insurance. Yet with no requirements about transparency, it’s hard to know where 340B revenue is going.
In Illinois, approximately 114 hospitals participate in 340B, and they earn approximately 2.7 times more revenue from the program than they spend on charity care annually. These large, tax-exempt hospitals are drawing more revenue from 340B while providing less charity care than their for-profit counterparts. If this is truly a program to provide care for the vulnerable, why are uninsured patients still being charged full price, pushed into medical debt, and sent to collections for trying to access medications that are covered under 340B pricing?
The expansion of pharmacies contracted with 340B hospital systems deserves scrutiny. Despite being a program designed to support low-income patients, more than half of all 340B contract pharmacies in Illinois are located in affluent neighborhoods. These for-profit entities are now positioned in the middle of what is supposed to be a nonprofit safety-net program, and they’re getting a cut of the revenue. A better approach would be to delink their profit from the drug price, removing the incentive for abuse that permeates 340B today.
We would like to see lawmakers differentiate the treatment of small hospitals and clinics using 340B to help patients from the large systems using it as a revenue strategy. Some community hospitals and clinics are doing the right thing, including passing 340B savings to patients and using the revenue to deliver affordable patient care. They should be recognized and protected. The growth in 340B among large systems generating significant revenue while delivering inadequate charity care and services should be examined.
This session, Illinois lawmakers are considering HB 2371, which would codify the current flaws in 340B, expanding the program and making meaningful oversight nearly impossible. That would move Illinois in exactly the wrong direction. Lawmakers should instead require 340B savings to reach patients directly, support real charity care, and show the public where the money is going.
Diabetes disproportionately impacts low-income and minority communities. At the same time, medical costs for patients with diabetes are about 2.6 times higher than for those living without the disease. 340B exists to support this very intersection of need and access, but today it’s failing patients and propping up large health enterprises.
By demanding transparency and accountability in 340B, Springfield can show patients across the state that making healthcare accessible and affordable is a priority this session.
Erin Callahan is Chief Operating Officer of the Diabetes Patient Advocacy Coalition, and a lifelong Illinois resident living with type 1 diabetes.
George Huntley is CEO of the Diabetes Patient Advocacy Coalition and lives with type 1 diabetes.
OpEd: llinois patients are paying for flaws in 340B program
